Evan M Graboyes1,2, Chanita Hughes Halbert2,3, Hong Li2,4, Graham W Warren2,5,6, Anthony J Alberg7, Elizabeth A Calhoun8, Brian Nussenbaum9, Courtney H Marsh1, Jessica McCay1, Terry A Day1, John M Kaczmar10, Anand K Sharma5, David M Neskey1,2, Katherine R Sterba2,4. 1. Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC. 2. Hollings Cancer Center, Medical University of South Carolina, Charleston, SC. 3. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC. 4. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 5. Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC. 6. Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC. 7. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC. 8. Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, AZ. 9. American Board of Otolaryngology-Head and Neck Surgery, Houston, TX. 10. Department of Medicine, Division of Medical Oncology, Medical University of South Carolina, Charleston, SC.
Abstract
PURPOSE: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS: Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS: In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION: This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.
PURPOSE: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS: Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS: In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION: This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.
Authors: Stephen H Taplin; Rebecca Anhang Price; Heather M Edwards; Mary K Foster; Erica S Breslau; Veronica Chollette; Irene Prabhu Das; Steven B Clauser; Mary L Fennell; Jane Zapka Journal: J Natl Cancer Inst Monogr Date: 2012-05
Authors: Samantha Hendren; Nancy Chin; Susan Fisher; Paul Winters; Jennifer Griggs; Supriya Mohile; Kevin Fiscella Journal: J Natl Med Assoc Date: 2011-08 Impact factor: 1.798
Authors: John D Cramer; Sedona E Speedy; Robert L Ferris; Alfred W Rademaker; Urjeet A Patel; Sandeep Samant Journal: Cancer Date: 2017-07-20 Impact factor: 6.860
Authors: Karen M Freund; Tracy A Battaglia; Elizabeth Calhoun; Julie S Darnell; Donald J Dudley; Kevin Fiscella; Martha L Hare; Nancy LaVerda; Ji-Hyun Lee; Paul Levine; David M Murray; Steven R Patierno; Peter C Raich; Richard G Roetzheim; Melissa Simon; Frederick R Snyder; Victoria Warren-Mears; Elizabeth M Whitley; Paul Winters; Gregory S Young; Electra D Paskett Journal: J Natl Cancer Inst Date: 2014-06-17 Impact factor: 13.506
Authors: Lawrence A Palinkas; Sarah M Horwitz; Carla A Green; Jennifer P Wisdom; Naihua Duan; Kimberly Hoagwood Journal: Adm Policy Ment Health Date: 2015-09
Authors: Evan M Graboyes; Anvesh R Kompelli; David M Neskey; Emily Brennan; Shaun Nguyen; Katherine R Sterba; Graham W Warren; Chanita Hughes-Halbert; Brian Nussenbaum; Terry A Day Journal: JAMA Otolaryngol Head Neck Surg Date: 2019-02-01 Impact factor: 6.223
Authors: Allen S Ho; Sungjin Kim; Mourad Tighiouart; Alain Mita; Kevin S Scher; Joel B Epstein; Anna Laury; Ravi Prasad; Nabilah Ali; Chrysanta Patio; Jon Mallen-St Clair; Zachary S Zumsteg Journal: Cancer Date: 2018-05-09 Impact factor: 6.860
Authors: Aaron T Seaman; Kristen L Seligman; Khanh K Nguyen; Zaid Al-Qurayshi; Nicholas D Kendell; Nitin A Pagedar Journal: Cancer Date: 2021-08-30 Impact factor: 6.860
Authors: Christopher W Noel; Yue Jennifer Du; Elif Baran; David Forner; Zain Husain; Kevin M Higgins; Irene Karam; Kelvin K W Chan; Julie Hallet; Frances Wright; Natalie G Coburn; Antoine Eskander; Lesley Gotlib Conn Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-04-01 Impact factor: 8.961
Authors: Nicholas R Lenze; Jeannette T Bensen; Laura Farnan; Siddharth Sheth; Jose P Zevallos; Wendell G Yarbrough; Adam M Zanation Journal: OTO Open Date: 2021-12-12
Authors: Shady I Soliman; Farhoud Faraji; John Pang; Loren K Mell; Joseph A Califano; Ryan K Orosco Journal: Cancers (Basel) Date: 2022-09-17 Impact factor: 6.575
Authors: Evan M Graboyes; Katherine R Sterba; Hong Li; Graham W Warren; Anthony J Alberg; Elizabeth A Calhoun; Brian Nussenbaum; Jessica McCay; Courtney H Marsh; Nosayaba Osazuwa-Peters; David M Neskey; John M Kaczmar; Anand K Sharma; Jennifer Harper; Terry A Day; Chanita Hughes-Halbert Journal: JCO Oncol Pract Date: 2021-03-10
Authors: Zachary A K Frosch; Nicholas Illenberger; Nandita Mitra; Daniel J Boffa; Matthew A Facktor; Heidi Nelson; Bryan E Palis; Justin E Bekelman; Lawrence N Shulman; Samuel U Takvorian Journal: JAMA Netw Open Date: 2021-07-01